FINANCIAL ASSURANCE THROUGH ASSIGNMENT OF ACCOUNT
______[Assignor],
hereinafter called “Assignor,” whose principal place of business is
______[Name and Address of Business],
does hereby assign and set over to the Department of Environmental Quality of the State of Oregon, all right, title, and interest of whatever nature of Assignor, in and to the insured account of Assignor located at the
______[Name and Address of Financial Institution],
and evidenced by a certificate or passbook in the amount of $______, numbered
______, which is delivered to the Department of Environmental Quality of the State of Oregon herewith.
Assignor agrees that this assignment carries with it the right in the insurance of the account by the Federal Savings and Loan Insurance Corp. or Federal Deposit Insurance Corp. and includes and gives the right to the Department of Environmental Quality of the State of Oregon to redeem, collect, and withdraw the full amount of such account at any time WITHOUT NOTICE TO THE ASSIGNOR. Assignor agrees to renew and continue said account during the period Assignor holds a Department permit, and until notified in writing by the Department that no further financial assurance is necessary for this purpose under Oregon Administrative Rule 340-094-0140(3)(d) or 340-095-0090(3)(d). Interest on the account is payable to the Assignor.
Assignor hereby notifies the above-named financial institution of this assignment.
Dated this____ day of ______, 20__.
______
(Corporate Seal)Assignor
By: ______
President
By:______
Secretary
RECEIPT FOR NOTICE OF ASSIGNMENT
Receipt is hereby acknowledged to the Department of Environmental Quality of the State of Oregon of written notice of the assignment to said Department of the account and certificate identified above. We have noted in our records the Department’s interest in said account as shown by the above assignment and have retained a copy of this document. We certify that we have received no notice of any lien, encumbrance, hold, claim or obligation affecting the above identified account prior to the assignment to the Department of Environmental Quality of the State of Oregon. We certify that the account is fully insured by the Federal Savings and Loan Insurance Corp. or Federal Deposit Insurance Corp. We agree to make payment to the Department of Environmental Quality of the State of Oregon upon request in accordance with the laws applicable to this institution, to provide prior notice to the Department of any activity with respect to this account, and to hold the amount specified for the Department unless otherwise notified in writing by the Department that the hold may be released. We further agree that this assignment will remain in effect and continue to be valid on all succeeding instruments until revoked in writing and signed by a fiscal representative of the Department of Environmental Quality.
Dated this ____ day of ______, 20__.
______
Name of Financial Institution
By: ______
Signature of Authorized Officer
______
Name and Title of Authorized Officer
______
StreetCity Zip
RECEIPT FOR CERTIFICATE AND
DIRECTION TO PAY EARNINGS
Receipt is acknowledged of the above assignment and the certification identified in the above assignment. The financial institution named in the above assignment is hereby authorized and directed to pay any earnings on the above-identified account to the above-mentioned Assignor until otherwise notified in writing by the Department of Environmental Quality of the State of Oregon.
Dated this___ day of ______, 20__.
DEPARTMENT OF ENVIRONMENTAL QUALITY OF THE STATE OF OREGON
By: ______
Fiscal Representative
______
Name
______
Title
EXECUTED IN TRIPLICATE ORIGINALS (Security must be filed with DEQ)
FINANCIAL ASSURANCE THROUGH ASSIGNMENT OF ACCOUNT (2/27/12 Update)
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